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Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Abi Khalil, Charbel, Ignatiuk, Barbara, Erdem, Guliz, Chemaitelly, Hiam, Barilli, Fabio, El-Shazly, Mohamed, Al Suwaidi, Jassim, Aboulsoud, Samar, Kofler, Markus, Stastny, Lukas, Jneid, Hani and Bonaros, Nikolaos (2021) Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis. Scientific Reports, 11 (1). ISSN 2045-2322

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Identification Number: 10.1038/s41598-021-91548-x

Abstract

Transcatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

Item Type: Article
Official URL: https://www.nature.com/srep/
Additional Information: © 2021 The Authors
Divisions: Health Policy
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine
R Medicine > RD Surgery
Date Deposited: 24 Jun 2021 13:24
Last Modified: 20 Sep 2021 03:22
URI: http://eprints.lse.ac.uk/id/eprint/110929

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